Botox Is More Affordable Than Ever. Is That A Good Thing?
Botox is everywhere right now. It’s nearly impossible to walk down a city block or through a suburban strip mall without seeing signs in med spas or even hair salon windows advertising it—sometimes at appealingly reasonable prices. The brand name for botulinum toxin (others include Daxxify, Dysport, and Xeomin), Botox has become so ubiquitous that what was once a hush-hush anti-aging “tweakment” for celebrities and those with means is now a household name, with people throwing Botox parties and twenty-somethings getting preventative 'Baby Botox' injections to stave off the signs of aging.
And with mass appeal comes mass pricing. On social media, some aestheticians are offering Botox for as little as $7 a unit. Search “cheap Botox near me” on Google, and you’ll get a long list of local deals, mainly from Groupon, where the drug is deeply discounted. (One such offer I recently spied boasted 40 units for $201—and would-be consumers could shave $20 off that price by applying a promo code.) That’s less than $5 per unit.
Let's put that in perspective. Sources say the pharmaceutical company that manufactures Botox, Allergan, charges providers around $6-7 per unit, making the average patient cost more like $10-15 per unit (with metropolitan areas charging double that), according to the American Society of Plastic Surgeons. Do the math, and it comes out to about $528 per treatment.
So how are some offering it for half that?
It’s a sticking point in the industry, with many calling these prices far too good to be true. “In my mind, the only way to offer Botox for that steep of a discount is if it’s not real—either counterfeit, from another country, or toxin that’s just literally fallen off the back of a truck,” says Bradley Glodny, MD, a cosmetic dermatologist who practices in New York City.
But surely that’s...hyperbole? Maybe not: In April, Dr. Glodny’s concerns were validated when the FDA reported that counterfeit Botox was administered in 11 states, including California, Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, Texas, and Washington between November 2023 and March 2024. Twenty-two women ranging in age from 25 to 59 reported symptoms of botulism, including drooping eyelids, blurred vision, slurred speech, and muscle weakness, after receiving injections from unlicensed or untrained injectors or in non-healthcare settings, such as homes and spas.
Some cases were so severe they required hospitalization.
At first glance, the fake vials look strikingly similar to genuine Botox, but there are subtle differences. For starters, the faux bottles are labeled “botulinum toxin type A” instead of “onabotulinumtoxinA” and contain 150 units (Botox is only available in vials of 50, 100, or 200 units). Another clue is a foreign language on the packaging, according to the FDA.
So, what can you, as a person who may be toxin-curious, do to protect yourself? Plenty. Let’s start here.
First, should you get Botox at a med spa?
Based on the number of reaction posts on social media from cosmetic dermatologists, plastic surgeons, and aesthetic nurses, the recent cases of counterfeit Botox have fueled a longstanding debate in the industry: Who should be injecting these neurotoxins? And why has this luxury medical procedure become something patients—and some providers—are willing to bargain for?
Some point to the boom in medical spas across the country coupled with fuzzy, if not flat-out lax, regulations, which have made minimally invasive medical procedures such as Botox more accessible and, in some cases, affordable. According to Market Data Enterprises, it’s a 17.5-billion-dollar industry, with nearly 9,000 medical spas operating across the US in 2022 (up from over 5,000 in 2017). Industry revenues have tripled since 2012.
Med spa regulations vary from state to state. In general, practitioners must be licensed physicians or advanced practice registered nurses (APRNs), and many—but not all—require businesses to employ a medical director who is a licensed physician. In Texas, for example, med spas must have a physician medical director, but they don’t have to be on-site, says Kristin Gunn, a licensed medical aesthetician and co-owner of Beaux MedSpa in Austin, whose partner is an on-site plastic surgeon. “Texas is trying to change that, but right now, as long as you have an MD on staff, even if they’re based 200 miles away, any nurse can inject.”
So, has the increase in med spas made Botox and other neurotoxins more affordable? Not exactly. Allegan has reportedly increased its prices for providers recently. However, there are more options now, such as Dysport and Xeomin, which may cost providers less to buy. “Just like any other consumer product, if you have a larger number of players, there’s going to be competitive pricing,” says Gabby Garritano, a board-certified physician assistant and founder of JECT NYC, a med spa with locations in New York, Los Angeles, and Miami. Buying in bulk from pharmaceutical companies also reduces costs, so large dermatology practices and med spas that do high volumes of injectables may be able to offer lower prices. “The more you buy, the less pricey it gets,” says Gunn.
Still, those $7 unit sales give even the busiest med spa owners pause. It doesn’t always mean they’re using counterfeit neurotoxin, but “some spas will promote a new injector with deals on Groupon in an attempt to build up their clientele,” says Garritano. New injector equals less experience, so proceed with caution, say our experts. “When you see those sales, like 30 units for $199 or even $299, that’s a huge red flag,” says Gunn. "Even more of a concern than counterfeit product is that the people typically offering lower prices are those with less experience,” says Gunn.
Another consideration: Less expensive neurotoxins may be the real deal, but watered down. “When the vials arrive at a med spa or physician’s office, they contain powder, and you can have to reconstitute it with sterile saline,” says Gunn. Some people use too much saline on purpose, so you’re getting a diluted version.” That means you’re getting less, which won’t last as long.
The cost of experience
In the end, your bill isn’t only based on how much your provider pays for the product, but also the injector’s skill and experience level. Marina Peredo, MD, a cosmetic dermatologist in New York City and Dix Hills, New York, has been injecting Botox since it was first FDA-approved as a cosmetic treatment in 2002. She’s a national investigator and educator for pharmaceutical companies such as Allergan, Galderma, and Merz. “Botox and fillers are tools,” Dr. Peredo says. “The results are in the hands of the injector. Can you really trust someone who just took a weekend course in aesthetics to stick needles in your face?”
Both Drs. Peredo and Glodny would leave aesthetic injections up to board-certified dermatologists or plastic surgeons with extensive training, hands-on experience, and a proven track record of excellence. “A PA or nurse may be very good, but they’re only as good as the MD who trained them—they get zero to no actual dermatologic training in school,” says Dr. Glodny. “So, it’s all about their clinical experience and an MD taking the time to train them.”
The Price is Right: Many cosmetic dermatologists, including Drs. Peredo and Glodny, don’t price by the unit. Instead, they offer a per-area (like crow’s feet) fee. “I stopped haggling over units a while ago,” says Dr. Glodny. “I charge per area and then do a complimentary touch-up in two weeks,” he says. “Other places might charge a lower dollar amount per unit, but they may be lying about the number of units they give you, it’s diluted, or it’s not real,” he says.
And it’s not just about injecting; the provider needs to handle bad reactions, which can occur even in the hands of the most skilled injector. “One of my mentors told me a long time ago, ‘Never perform a procedure where you won’t be able to handle the adverse effects,’ and that’s a super important rule to work by,” Dr. Glodny says.
Of course, finding a qualified cosmetic dermatologist in a metropolitan area is far easier than in other parts of the country, where dermatologist droughts exist. In those cases, med spas may be your best option. But do your homework: “I would ask where they did their training and how many years of experience they have,” Dr. Glodny says. “There are some nurse practitioners and PAs who train for Allergan and Galderma; I would feel more comfortable going to one of them,” he says.
The med spa owners we interviewed agreed that upper-level training is key for nurses, too. “We had 60 trainings last year alone at JECT for our medical providers,” says Garritano. "We don’t just offer an onboarding program; we provide continuous training." Gunn, who has been injecting neurotoxins for 15 years, trained with a plastic surgeon for an entire year before she started in the biz. “I would use the white pencil to mark the points on patients’ faces; he’d wipe them away and say, ‘Try again!’”
Worth a shot?
Even top cosmetic dermatologists will hold a sale here and there, and pharmaceutical companies offer coupons and incentives for treatments. That’s all fine. But when a price seems too good to be true, it likely is, and requires careful vetting. Aside from asking to see the vial of your neurotoxin and requesting a full curriculum vitae from your injector (we’re serious about both of those suggestions), how can you navigate Botox safely?
What to keep in mind:
Remember, it’s a medical procedure. The Botox boom has brought patients away from the clinical setting. It’s being done not only at med spas but at parties in apartments, hair salons, and unsafe locations. “When we inject, everything is clean, sterile, and everyone is gloved,” says Dr. Peredo. “If you’re at a Botox party and there’s alcohol involved, that’s not a proper way to do it."
Check references. Read reviews on Google and Yelp and get word-of-mouth referrals from friends who have been to the injector.
Keep in mind that not all MDs are qualified. Just because someone is a licensed physician, it doesn’t mean they are competent to inject. Board-certified dermatologists and plastic surgeons are the physicians you want to look for. “There are so many nuances with injecting,” says Dr. Peredo. “I look at the face; I look at the skin quality; I may use a combination of different neurotoxins. A gynecologist should not be doing Botox.” The same goes for dentists. “I’m an aesthetic dermatology office, but I won’t offer teeth whitening because teeth are not my specialty,” Dr. Peredo adds. “I’ve treated so many complications from dentists doing Botox; it’s hard to undo, and they’re giving the industry a bad reputation.”
Stop bargain hunting. “We need to remember that this is a luxury procedure, so don’t cut corners,” says Peredo. It’s worth saving your cash until you can do it right. “If price is your main concern, it’s probably not the treatment for you.”
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